Female Genital Mutilation, Ivy League Edition

Should surgeons promote an aesthetic standard for little girls’ genitals? Pediatric urologist Dix Poppas thinks so, and he’s more than happy to slice and dice away any deviations in the size and shape of your daughter’s clitoris.

This elective butchery of little girls isn’t based on the edict of some Muslim cleric in Yemen or Egypt. Instead, this is medical advice from a respected, board certified Cornell University researcher who performs these partial clitoridectomies on infants and children at New York-Presbyterian Hospital.

Poppas carries out these surgical assaults on girls born with cosmetically atypical genitalia that he deems masculine or ambiguous in appearance. Some of his patients undergo this cosmetic procedure at under six months of age after Poppas tells their parents that with surgical “correction,” a “normal physiologic, emotional, and sexual development can be achieved.”

But is there evidence that girls with large clitorises are at risk of developmental problems? Not at all, say Alice Dreger and Ellen K. Feder in a new Bioethics Forum commentary:

For over a decade, many people (including us) have criticized this surgical practice. Critics in medicine, bioethics, and patient advocacy have questioned the surgery’s necessity, safety, and efficacy. We still know of no evidence that a large clitoris increases psychological risk (so is the surgery even necessary?), and we do know of substantial anecdotal evidence that it does not increase risk. Importantly, there also seems to be evidence that clitoroplasties performed in infancy do increase risk — of harm to physical and sexual functioning, as well as psychosocial harm.

This isn’t the equivalent of surgically treating a disabling cleft palate; it’s the risky, medically unnecessary reduction of a sexual organ. It doesn’t improve function or hygiene; instead, it jeopardizes future sexual sensation for the frivolous goal of ensuring these girls fit in with the other kids when they play “I’ll show you mine.”

Columnist Dan Savage writes, “There’s lots to be outraged about here: there’s nothing wrong with these girls and their healthy, functional-if-larger-than-average clitorises; there’s no need to operate on these girls; and surgically altering a girl’s clitoris because it’s “too big” has been found to do lasting physical and psychological harm.” And Slate‘s Rachael Larimore observes, “One doesn’t have to be a doctor to realize that this is nothing less than the same genital mutilation that women regularly undergo in Africa and the Middle East. But it’s happening at one of our top institutions of higher learning.”

Indeed, sterile blades and lip service paid to the preservation of clitoral sensation are the only things distinguishing this genital mutilation from the ritual excisions that permanently scar millions of women around the world.

Dr. Poppas contends that his clitoral reduction surgery isn’t misogynist quackery because it utilizes a “nerve-sparing” technique designed to minimize sexual dysfunction. How does he know? He uses vibrators to stimulate the girls’ clitorises during followup exams.

At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time.

I guess that’s one way to explain why you have a lifetime supply of Trojan Vibrating Touch personal massagers stashed in your closet: “But officer, they’re for the children!”

Unsurprisingly, Dreger and Feder were unable to find another pediatric urologist who uses this “ground breaking” post-surgical kiddie diddling technique. What’s more, Poppas knows that inflicting this sort of trauma on children is far beyond the bounds of acceptable scientific practice. That’s why he didn’t bother to obtain IRB approval for his unorthodox use of “vibratory devices.” Dreger explains:

If he had sought IRB approval for the “sensory testing,” the ethics staff might have sat up and asked him what the heck he thought he was doing to these girls, and they would have tried to make sure the parents were informed about the unknowns and risks, and the girls could have refused to participate.

Perhaps Dix Poppas (whose name could inspire an entire Freudian treatise) thinks his work is so important that ethical boundaries don’t apply. Maybe he’s simply a child molester who takes sadistic pleasure in mutilating and traumatizing the most vulnerable among us. Either way, we can’t allow his battery of little girls to go on, not for one more day.